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Decline in Clostridium difficile-associated disease rates in Singapore public hospitals, 2006 to 2008
Li-Yang Hsu, Thean Tan, Tse Koh, Andrea L Kwa, Prabha Krishnan, Nancy W Tee, Roland Jureen
BMC Research Notes , 2011, DOI: 10.1186/1756-0500-4-77
Abstract: Laboratory and pharmacy data were collated from one tertiary and two secondary hospitals on a quarterly basis between 2006 and 2008. All hospitals tested for C. difficile using Immunocard Toxins A&B (Meridian Bioscience Inc., Cincinnati, OH) during this period. Duplicate positive C. difficile results within a 14-day period were removed. The CDAD results were compared with trends in hospital-based prescription of major classes of antibiotics.Overall CDAD incidence-density decreased from 5.16 (95%CI: 4.73 - 5.62) cases per 10,000 inpatient-days in 2006 to 2.99 (95%CI: 2.67 to 3.33) cases per 10,000 inpatient-days in 2008 (p < 0.001), while overall rates for C. difficile testing increased significantly (p < 0.001) within the same period. These trends were mirrored at the individual hospital level. Evaluation of antibiotic prescription data at all hospitals showed increasing use of carbapenems and fluoroquinolones, while cephalosporin and clindamycin prescription remained stable.Our results demonstrate a real decline of CDAD rates in three large local hospitals. The cause is unclear and is not associated with improved infection control measures or reduction in antibiotic prescription. Lack of C. difficile stool cultures as part of routine testing precluded determination of the decline of a major clone as a potential explanation. For more accurate epidemiological trending of CDAD and early detection of epidemic clones, data collection will have to be expanded and resources set in place for reference laboratory culture and typing.Clostridium difficile is an anaerobic Gram-positive bacillus that is the major cause of pseudomembranous colitis associated with antibiotic use, accounting for 15%-25% of nosocomial cases of antibiotic-associated diarrhea [1,2]. The spread of the hypervirulent epidemic ribotype 027/NAP-1 strain across hospitals in US, Canada and Europe amidst rising incidence and mortality of C. difficile-associated disease (CDAD) in the past decade has re-focuse
Clostridium Difficile
MODABER
Acta Medica Iranica , 1975,
Abstract: Seventy-five meconium samples were examined for the presence of CI. difficile: 3 strains were isola ted. Additionally 45 labora tory animal faeces specimens were tested for the same purpose, a further 2 cases were isolated. These five suspicious strains were identified as CI. difficile acco rding to the tests mentioned in the previous paragraphs. The organisms . isolated here showed the same characteristics as five of the strains received and also as the organisms isolated from the inoculated animals with the crude cultures of CI. difficile. These organisms were variable in size, roughly 2-9 XO.3-0. 8u, Gram positive rods, moti le, capsulated, fl agellated, most probably peritrichous, possessing non-bulging spores located terminally or msubterminally, free spores were-rarely detectable. Cell arrangements : singly or in pairs and occasionally in short chains. On longer incubation the organisms slightly shifted to become Gram variable and longer in size. Colonies on ordinary aga r and solid blood agar appeared to be punctiform and rough. On the other hand the colony appearance on the rest of the solid media which are mentioned previously a re as fo llows: 1-3 mm in diameter, greenish, smooth, non-haemolytic, entire some showing slight irregularities of their edges. Colonies slightly raised, butyrous and semi opaque to opaque. This organism does not liquify the serum of Loeffler medium and also does not cause any changes of this medium. The metachromatic granules are readily seen by Albert's staining. Neither proteolytic nor lipolytic activi ties are possessed by this organ ism. Sensitivity to antibiotics showed the same pattern as mentioned about the strains received. H?S production was positive after 48 hours. All the strains reduce nitrates. Most of the strains produce Indole and none liquify gelatin and also none produce any changes in Litmus Milk medium. The agglutinating serum prepared in rabbits as mentioned before were tested against heated and formolised suspensions of the strains isolated; serum produced against strain A3 agglutinated to some extent all the strains tested. The 0 I and EI were agglutinated to a greater degree than the homologous strain. The strains 02 and 03 were flocculated equally as the homologous strain. Furthermore E2 strain was also agglutinated at the I in 640 serum dilution. An effective antiserum was produced in rabbits by injecting with CI. difficile toxoid.
The Enterotoxicity of Clostridium difficile Toxins  [PDF]
Xingmin Sun,Tor Savidge,Hanping Feng
Toxins , 2010, DOI: 10.3390/toxins2071848
Abstract: The major virulence factors of Clostridium difficile infection (CDI) are two large exotoxins A (TcdA) and B (TcdB). However, our understanding of the specific roles of these toxins in CDI is still evolving. It is now accepted that both toxins are enterotoxic and proinflammatory in the human intestine. Both purified TcdA and TcdB are capable of inducing the pathophysiology of CDI, although most studies have focused on TcdA. C.?difficile toxins exert a wide array of biological activities by acting directly on intestinal epithelial cells. Alternatively, the toxins may target immune cells and neurons once the intestinal epithelial barrier is disrupted. The toxins may also act indirectly by stimulating cells to produce chemokines, proinflammatory cytokines, neuropeptides and other neuroimmune signals. This review considers the mechanisms of TcdA- and TcdB-induced enterotoxicity, and recent developments in this field.
Recent changes in Clostridium difficile infection
Silva Júnior, Moacyr;
Einstein (S?o Paulo) , 2012, DOI: 10.1590/S1679-45082012000100023
Abstract: clostridium difficile is the main cause of nosocomial diarrhea. diarrhea associated with c. difficile has increased incidence, morbidity, and mortality in the last few years. the major related risk factors include use of antibiotics, elderly patients and prolonged hospital stay. many patients receive combinations of antibiotics or multiple antibiotics, which represents the main risk to develop diarrhea associated to c. difficile or its recurrence. therefore, interventions to improve antibiotic prescribing, as well as compliance with infection control measures can reduce hospital-acquired c. difficile infections. this review addresses the epidemiological changes in c. difficile disease and its treatment.
Recent changes in Clostridium difficile infection  [PDF]
Moacyr Silva Júnior
Einstein (S?o Paulo) , 2012,
Abstract: Clostridium difficile is the main cause of nosocomial diarrhea. Diarrhea associated with C. difficile has increased incidence, morbidity, and mortality in the last few years. The major related risk factors include use of antibiotics, elderly patients and prolonged hospital stay. Many patients receive combinations of antibiotics or multiple antibiotics, which represents the main risk to develop diarrhea associated to C. difficile or its recurrence. Therefore, interventions to improve antibiotic prescribing, as well as compliance with infection control measures can reduce hospital-acquired C. difficile infections. This review addresses the epidemiological changes in C. difficile disease and its treatment.
TREATMENT OF CLOSTRIDIUM DIFFICILE- ASSOCIATED DISEASE  [PDF]
Predrag Stojanovic,Branislava Kocic,Gordana Randjelovic,Dobrila Stankovic-Djordjevic
Acta Medica Medianae , 2007,
Abstract: Clostridium difficile is a Gram-positive, spore-forming, anaerobic bacillus that is widely distributed in the environment, but is found as a part of a normal large bowel flora in approximately 3% of normal adults. C. difficile produces two protein exotoxins: toxin A and toxin B. Both toxins are responsible for causing the sings and symptoms of disease.C. difficile is now thought to be responsible for a spectrum of diseases, ranging from asymptomatic colonization to diarrhea of varying severity, life-threatening colitis, often as a consequence of long-term antibiotic exposure. This spectrum has become known as C. difficile-associated disease (CDAD).Treatment of Clostridium difficile-associated disease demand administration of effi-cient antibiotics (vancomycin, metronidazole), anion exchange resins and probiotics (Lactobacillus spp., Saccharomyces boulardii).
Abordaje multidisciplinario de la infección por Clostridium difficile Multidisciplinary approach of Clostridium difficile infection  [cached]
Marta Pérez,Ana I Hurtado,Ignacio Couto,José Ma Gutiérrez
Revista chilena de infectología , 2013,
Abstract: Clostridium difficile es la causa más común de diarrea infecciosa en instituciones sanitarias de adultos. Estudios recientes han mostrado un incremento en la incidencia, gravedad y recurrencia de la infección por C. difficile (ICD).Factores asociados al paciente y a la atención sanitaria contribuyen a establecer la colonización y en algunos casos la posterior progresión a enfermedad sintomática. La disponibilidad de nuevas técnicas microbiológicas ha contribuido en gran medida a mejorar el manejo de estos pacientes. Se muestra un algoritmo diagnóstico ante la sospecha de ICD basándose en la evidencia actual sobre la rentabilidad de métodos microbiológicos y radiológicos. Ante la confirmación clínica de ICD la primera medida y la más eficaz es la retirada del tratamiento antimicrobiano que tenga el paciente, si es posible. El tratamiento antimicrobiano de la ICD se basa en tres agentes clásicos, metronidazol, vancomicina y teicoplanina, y uno de reciente incorporación, fidaxomicina. En los cuadros graves se deberán instaurar medidas de soporte y monitorización adecuadas y pueden ser subsidiarios de tratamiento quirúrgico. Las estrategias de prevención y control de la infección permiten interrumpir el mecanismo de transmisión. Este manuscrito revisa la evidencia actualsobre el abordaje de esta entidad desde un punto de vista multidisciplinario. Clostridium difficile is the most common cause of infectious diarrhea in adults healthcare institutions. Recent studies have shown an increase in the incidence, severity and recurrence of C. difficile infection (CDI). Factors associated with the patient and medical care provided contribute to establishing colonization and, in some cases, subsequent progression to symptomatic disease. The availability of new microbiological techniques has contributed greatly to improving care for these patients. A diagnostic algorithm is provided for cases in which CDI is suspected based on current evidence regarding the effectiveness of microbiological and radiological methods. In cases in which CDI is confirmed, the first and most effective measure is the withdrawal of any antibiotic treatment the patient is receiving, if possible. The antimicrobial treatment of CDI is based on three classic agents: metronidazole, vancomycin and teicoplanin, along with the recent addition of fidaxomicin. Patients presenting serious symptoms, in addition to appropriate support and monitoring measures, may require surgical treatment. Infection prevention and control strategies can interrupt the transmission mechanism. This manuscript reviews current
CLOSTRIDIUM DIFFICILE: EPIDEMIOLOGY, DIAGNOSIS AND TREATMENT  [PDF]
Stojanovic Predrag,Kocic Branislava,Randjelovic Gordana,Mladenovic-Antic Snezana
Acta Facultatis Medicae Naissensis , 2006,
Abstract: Clostridium difficile is a Gram-positive, spore-forming, anaerobic bacillus widely distributed in the environment. However, it is found as a part of the normal large intestine flora in approximately 2% of normal adults. C. difficile is now thought to be responsible for a wide range of diseases from asymptomatic colonization, to diarrhea of varying severity, life-threatening colitis, often as a consequence of antibiotic exposure. This spectrum has become known as "C. difficile associated disease (CDAD)". Effective control of CDAD in the hospital requires both antibiotic control and prevention of environmental seeding and bacterial spread. Epidemic C. difficile strains are widely distributed in the hospital environment, both as a cause and result of nosocomial diarrhea. Current treatment options are antibiotic-based, which is less than ideal. The use of various biotherapeutic preparations was not as efficient as we expected.
Clostridium difficile phages: still difficult?  [PDF]
Katherine R. Hargreaves,Martha R. J. Clokie
Frontiers in Microbiology , 2014, DOI: 10.3389/fmicb.2014.00184
Abstract: Phages that infect Clostridium difficile were first isolated for typing purposes in the 1980s, but their use was short lived. However, the rise of C. difficile epidemics over the last decade has triggered a resurgence of interest in using phages to combat this pathogen. Phage therapy is an attractive treatment option for C. difficile infection, however, developing suitable phages is challenging. In this review we summarize the difficulties faced by researchers in this field, and we discuss the solutions and strategies used for the development of C. difficile phages for use as novel therapeutics. Epidemiological data has highlighted the diversity and distribution of C. difficile, and shown that novel strains continue to emerge in clinical settings. In parallel with epidemiological studies, advances in molecular biology have bolstered our understanding of C. difficile biology, and our knowledge of phage–host interactions in other bacterial species. These three fields of biology have therefore paved the way for future work on C. difficile phages to progress and develop. Benefits of using C. difficile phages as therapeutic agents include the fact that they have highly specific interactions with their bacterial hosts. Studies also show that they can reduce bacterial numbers in both in vitro and in vivo systems. Genetic analysis has revealed the genomic diversity among these phages and provided an insight into their taxonomy and evolution. No strictly virulent C. difficile phages have been reported and this contributes to the difficulties with their therapeutic exploitation. Although treatment approaches using the phage-encoded endolysin protein have been explored, the benefits of using “whole-phages” are such that they remain a major research focus. Whilst we don’t envisage working with C. difficile phages will be problem-free, sufficient study should inform future strategies to facilitate their development to combat this problematic pathogen.
Clostridium difficile infection in an Iranian hospital
Mohammad Jalali, Farzin Khorvash, Keith Warriner, J Weese
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-159
Abstract: Clostridium difficile was isolated from 19/89 (21%) stool samples of 17/86 (20%) patients. 13/17 (77%) cases of CDI were hospital-associated. Patients with CDI were significantly older (43 ± 28y) than those with non-CDI diarrhea (24, ± 26y)(P = 0.018). All isolates were toxigenic, and possessed genes encoding for toxins A and B. Six (32%) of 19 isolates also possessed cdtB. Twelve ribotypes were identified. Ribotype 078/toxinotype V was most common, accounting for 4 (21%) of isolates. A single isolate of a different toxinotype V ribotype was identified, as was a toxinotype XXIV isolate. The remaining isolates consisted of 9 different toxinotype 0 ribotypes.CDI is an important cause of diarrhea in patients in this hospital. The diversity of ribotypes was striking, and the number of different types suggests the presence of a broad range of strains in the community, the hospital or both. The predominance of toxinotype V strains, which have been associated with community-associated disease and food animals, was unexpected and possible sources of this type require further investigation.Clostridium difficile is a leading cause of hospital-associated and antimicrobial-associated diarhea, and is of significant concern because of the increasing morbidity, mortality and relapse rates [1], along with the emergence of community-associated disease [2]. Some of these clinical and epidemiological changes have been associated with dissemination of hypervirulent clones, particularly ribotype 027 (toxinotype III, North American pulsotype (NAP)1)[3] and to a lesser degree ribotype 078 (toxinotype V, NAP7/8) [4,5]. Clostridium difficile infection (CDI) has been reported throughout much of the world, but most data come from developed countries in North America and Europe. Limited information is available regarding the role of C. difficile in diarrheic hospital patients in people in Iran or other Middle Eastern countries, or about C. difficile strains that are involved. Therefore, the ai
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